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Submitted: 02 September 2007
HERDIN Record #: PCHRD090107020909

Value of myocardial perfusion scintigraphy in the short-term prognostication of post myocardial infarction patients .

Jerry M. Obaldo,
Alvin P. QuiÃÆââ

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BackgroundÃÆ'Æ'Æ’ÃÆ'†â€™ÃÆ'Æ'â€Ã...¡ÃÆ'‚¢ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â‚¬Ã...¡ÃÆ'‚¬ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â€Ã...¡Ã‚¬ÃÆ'‚ Myocardial perfusion scintigraphy (MPS) is an established imaging technique for prediction of cardiac events in patients with known coronary heart disease. The study aimed to determine the value of stress thallium-201 SPECT MPS for short-term prognostication in post-myocardial infarction (MI) patients.

Methods ÃÆ'Æ'Æ’ÃÆ'†â€™ÃÆ'Æ'â€Ã...¡ÃÆ'‚¢ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â‚¬Ã...¡ÃÆ'‚¬ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â€Ã...¡Ã‚¬ÃÆ'‚ The study group (n=64) consisted of 47 males and 17 females aged 28-78 (mean of 59 +/-11 years) who had recent MI and underwent exercise or dipyridamole SPECT MPS. Semi-quantitative analysis with visual scoring of perfusion images, was utilized using the 17-segment to derive the summed stress score (SSS), indicating the severity of stress defects, and the summed difference score (SDS), stress minus rest scores, indicating reversibility of defects, using the 4-point scale (0=no defect to 3= severe defect). The extent of perfusion defects was determined by the number of abnormal segments. Patients were followed up for the development of coronary events (revascularization or another Ml/cardiac death) over a period of 6 +/- 3 months. Clinical and scan parameters were correlated with the development of coronary events.

ResultsÃÆ'Æ'Æ’ÃÆ'†â€™ÃÆ'Æ'â€Ã...¡ÃÆ'‚¢ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â‚¬Ã...¡ÃÆ'‚¬ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â€Ã...¡Ã‚¬ÃÆ'‚ There were 14 coronary events (21 percent event rate) consisting of 9 revascularizations, 3 cardiac deaths and 2 Mis. The sex distribution (p = 0.847) and presence of diabetes (p=0.807), were not associated with the development of coronary events. Left ventricular (LV) dilatation was significantly more prevalent in the group with coronary events (p=0.042). The mean number of abnormal segments, SSS, and SDS were higher in the group with coronary events (9.29, 18.36 and 7.86, respectively) than in the group without coronary events (7.74, 13.76, and 5.7, respectively; p values of 0.093, 0.10, and 0.05, respectively). ROC curve analysis of the scores revealed the following suggested cut-off values with highest accuracy: number of abnormal segments e"8 (64 percent sensitivity, 50 percent specificity), SSS e"12 (71 percent sensitivity, 46 percent specificity), and SDS e"6 (86% sensitivity, 44% specificity).

Conclusion- LV dilatation and the reversibility of defects (SDS) were significantly worse in post-Mi patients developing cardiac events in the short term. Severity of stress defects (SSS) and the extent of perfusion abnormalities also tended to be higher in the coronary event group. The cut-off values for quantitation resulted in fairly high sensitivity and moderate specificity for predicting cardiac events, suggesting a strong negative predictive value for these parameters. (Author)

Publication Type
Journal
Publication Sub Type
Journal Article, Original
Title
Philippine Heart Center Journal
Frequency
Quarterly
Publication Date
January-March 2006
Volume
12
Issue
1
Page(s)
35-38

Objectives

The aim of the study is to determine the value of stress thallium-201 MPS for short-term prognostication in post MI patients.

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